Page 146 - claims information pack ebook_e

Example Claim Form - Instructions

Incident Name
instructions Claim Form

Introduction and instructions for completion and submission

This claim form is issued on behalf of [1] the If claimants suffer damage in a State that is
registered shipowner/[2] the shipowner’s Party to the Supplementary Fund Protocol, their
insurer/ and [3] the International Oil Pollution claims will automatically be considered for
Compensation Fund, 1992 (1992 Fund), (together compensation from the Supplementary Fund, if
the “compensation bodies”) and is to be used by the amount available from the shipowner/insurer
claimants submitting claims for compensation and the 1992 Fund is insufficient to pay full 1
for damage by oil pollution. compensation for proven losses.

Claims for damage by oil pollution from a spill Your attention is drawn to the fact that:
of persistent oil from a tanker are governed by a. Claims will only be admissible if they relate to
the 1992 Civil Liability Convention and the 1992 damage caused by oil pollution in a State which
Fund Convention, which have been ratified by is Party to the 1992 Fund Convention;
[country affected] and which form an integral
part of [country affected]'s laws. Compensation b. Claimants must provide supporting documents
claims resulting from the pollution caused by the or other evidence to prove their losses; and
spill of oil from the [vessel name] will therefore be c. Claimants must be able to prove that all
examined in the light of the conditions imposed reasonable measures were taken to avoid the
by these laws that are within the scope of the occurrence of the damage or to mitigate its
1992 Civil Liability Convention and the 1992 Fund effects.
Convention.
If you have suffered pollution damage and wish to
Under the 1992 Civil Liability Convention, claims make a claim, you should complete the relevant
for compensation for oil pollution damage caused sections of this claim form and:
by persistent oil may be made against [1] the
registered owner of the ship from which the 1) send it to the postal or email address
damage originated (or [2] his insurer). of the registered owner; or

Under the 1992 Fund Convention, additional 2) send it to the postal or email address
compensation is made available by [3] the of the shipowner’s insurer; or
1992 Fund when claimants do not obtain full 3) send it to the postal or email address
compensation under the 1992 Civil Liability of the 1992 Fund; or
Convention.
4) deposit with the claims handling office.